Babysitter Medical Consent Form

Everybody hiring a childcare professional needs a medical release for baby sitters in order to ensure their baby is able to receive emergency medical care while the nanny or baby sitter is taking care of the baby. It also ensures that medical institutions will be able to contact the brings up in the event that an emergency takes place.

This page is intended to serve as a resource for brings up seeking a babysitter medical consent form that they can use as part of their release package when hiring a nanny, baby sitter or au pair so that they are able to take care of your child in the case of an emergency. The form below was taken from the American Red Cross Infant CPR portion of the 2001 Red Cross First Aid/CPR/AED program.
This form is designed for parents to complete and provide an first copy with the nanny or designated caregiver. You can also offer information regarding your child’s allergies, medications or conditions.

Provided that you have one, point out the child’s Medic Alert tag to the nanny. The form is below and you can print and make numerous copies for you, your files and for your child’s caregiver to have available at all times.
Babysitter Consent and Contact Form

This form is to be filled in and signed by the child’s parent or legal custodial.

Name of child:___________________________________________

In the event the child named above is injured or ill, I understand that the caregiver will attempt to contact me, the other parent, or the legal guardian at the telephone number provided below.

Parent’s (legal guardian’s name:______________________

Telephone numbers __________________on ______________(hours/days)

___________________on ___________________(hours/days)

Parent’s (legal guardian’s) name: _______________________

Telephone numbers __________________on ______________(hours/days)

___________________on ___________________(hours/days)

In the event that I or the others listed are not available, I give my permission to the caregiver to provide first aid for the child named above and to take the appropriate measures including contacting the emergency medical services (EMS) system and arranging for transportation to ________________________________________

or the nearest emergency medical facility. At no time will the caregiver drive an ill or injured child to an emergency medical facility unless accompanied by another adult.

Signature ___________________________ Date _______________

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